VAHHS Legislative Report

For the week ending May 27, 2005

Political Overview

With approximately a week remaining in the session, frequent back door negotiations are taking place and nerves are getting very raw. Lobbyist, legislators and the Administration agree that adjournment needs to happen quickly. A coalition of business groups held a press conference yesterday afternoon arguing that a number of initiatives making their way through the Legislature this year would be a drain on businesses, especially small businesses struggling to survive.

The two big issues left are the budget and health care reform. Senator Susan Bartlett, D-Lamoille and Chair of the Appropriations Committee, set a fire under the seats of conferees that she wants agreement on the budget by Thursday, June 2 in order to be adjourned by the end of next week. Senator Bartlett laid out the very rigorous schedule late yesterday afternoon. House conferees are not as optimistic as the Senator that things will be wrapped up that quickly. This will elevate the work of the health reform conference committee as well as any remaining committee work. The Governor continues to be opposed to a payroll tax and is advocating for a premium tax on insurers. This tax dispute may likely be the deal breaker on health reform.

Both the House and Senate spent most of the week on the floor. The Senate debated the Appropriations bill for nearly two full days and the House spent much of its time on civil commitment for violent offenders who have served their jail time. The legislation would allow the state to hold some mentally ill offenders who are likely to be repeat offenders. The Governor has made this a priority and House Republicans offered amendment after amendment to get this included on to the safe communities bill being debated on the floor.

VAHHS Issues

Budget and Medicaid
The Vermont Senate passed a $1 billion state budget this week. Many areas of the budget passed by the Senate are close to the House proposal, but one area that is significantly different is Medicaid. The Senate plan increases hospitals cuts to $17.95 million, physician cuts of $1.75 million, home health cuts of $500,000, dentist cuts of $243,309, and nursing home costs calculated using an occupancy rate of 93 percent.

VAHHS worked with the Senate leadership to draft language that would ease this year’s cuts by having hospitals settle outpatient claims to the Office of Vermont Health Access (OVHA). The interim rate setting and settlement process are significantly impacted by current delays between hospitals Medicare report filings and the final approval by fiscal intermediary auditors. Hospitals have outstanding settlements reaching as far back as FY 2002. This is a one time opportunity that capitalizes on the historical lag time inherent in OVHA’s Medicaid settlement process.

The Senate also included a placeholder for Certificate of Need (CON) regulatory relief for hospitals. VAHHS and the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) have worked out language around gap review and technical changes. Bea Grause will be testifying in front of both the House and Senate early next week to explain the provisions.

An agreement was resolved by all parties on the court ordered evaluations at designated hospitals (forensic evaluations). Due to concerns regarding implementation, the language in the budget bill includes a sunset date of July 2006 allowing time for a study committee to address issues related to (1) transfers between hospitals, including standards, procedures, and rights of patients; (2) determination of the least restrictive setting for the forensic evaluation; (3) disposition of the defendant if it is determined after admission that the defendant does not meet the standards for hospitalization; (4) legal representation of defendants and the state in hospitalization hearings; and (5) other issues as determined by the work group.

Also included in the budget is the health information technology and appropriation of $250,000 plus an additional appropriation of $750,000 for dollar-for-dollar matching funds to leverage resources necessary to fund pilot projects.

Health Care Reform
The conference committee continues to meet on a regular basis. The committee is basically in agreement with the goals, findings, health information technology, cost controls, equity and quality. VAHHS continues to have concerns related to global budgets and spending caps. It remains unclear whether House and Senate conferees will compromise on a health care reform bill this session. We will continue to work with the conferees on amending this language.

H. 115 – An Act Relating to Advance Directives for Health Care
The Senate Health & Welfare committee passed H. 115 this week. The bill passed second reading on Friday. There will be a big push to get this bill passed on the Senate floor Tuesday. Wendy Morgan of the Attorney General’s office has been working House committee members of both Judiciary and Human Services to agree to concur with the Senate proposal of amendment in order to avoid a conference committee.

H. 163 – An Act Relating To Criminal Abuse, Neglect, and Exploitation of Vulnerable Adults

As reported previously, the House did not concur with the Senate proposal of amendment to H. 163. The House conferees include: Representatives William Lippert of Hinesburg, Maxine Grad of Moretown, and Michael Kainen of Hartford. The Senate conferees appointed this week include: Senators Richard Sears of Bennington, John Campbell of Windsor and Kevin Mullin of Rutland.

H. 227 – An Act Relating To Safe Staffing and Quality Patient Care
The House General, Housing and Military Affairs committee again took up H. 227. Pat Jones, Director of Quality at BISHCA, presented a proposal to the committee. Chairman Francis Brooks has indicated to VAHHS that he will have one more hearing on this bill. He remains undecided on whether his committee will take action on this bill this session.

H. 241 – An Act Relating to Prohibition of Smoking in All Public Places

The House concurred with the Senate proposal of amendment and has been sent to the Governor and is awaiting his action. To view the language as accepted by both the House and Senate follow the link: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/passed/H-241.HTM

H. 543 – An Act Relating to Long Term Care Waiver

The House passed H. 543 on the floor this week. The bill proposes to direct the department of aging and independent living to implement a Medicaid 1115 waiver to allow home- and community-based long-term care services to be offered in the same manner as nursing home services and address issues relating to the waiver. The bill was referred to the Senate Health & Welfare committee. There is still a possibility that this will be included in the budget bill.

S. 40 - An Act Relating to Reducing Fires Resulting From the Careless Use of Cigarettes and to Other Tobacco-Related Issues

The House passed S. 40 on Thursday afternoon on a voice vote. Representative Chris Louras, R-Rutland, offered two amendments, with the House accepting on clarifying amendment. If the Senate accepts the changes made by the House the bill will go to the Governor for his signature. If not, a committee of conference will be appointed.

S. 174 – An Act Relating to Home Health Agencies
The House Health Care Committee passed S. 174 on an 11-0-0 vote today. The bill provides for enhanced state oversight of the practices and arrangements of home health agencies regarding access to and the cost and quality of home health services offered in Vermont. The House suspended its rules in order for immediate action be taken on the bill and was sent to the House Appropriations Committee. This will be on the House notice calendar for Tuesday.